Table 2 Stakeholder feedback on theories of patients’ acceptability of streaming (3rd November 2019)
Theory origin | Theory | Stakeholder feedback |
|---|---|---|
Patient-derived | A patient may present to the ED with a persistent problem for which they are finding it difficult to access care or for which they have been dissatisfied with the care received from their community primary care service (C). If they have no expectations of who they should be seen by at a hospital, trust the initial assessment process, and believe that they will get good advice at a hospital (M), then they may find the process of being streamed to a GP acceptable (O). | • Patients are usually happy if their expectations are met. • Timely access is important - patients just want to see a doctor - from their point of view they get to see a doctor the same day. • Acceptability depends on how unwell the patient feels and how worried they are about their health. • Sometimes a GP referral when patient wants a second opinion is less acceptable to the patient. • Patient assumptions that ‘better’ advice is received in ED than GP – not necessarily true. • A good GP can be better than lots of investigations. |
Clinician-derived | If a patient is streamed to a GP because they are the most appropriate clinician with the best knowledge and experience for the complaint(C) and an ED nurse explains this reasoning to the patient, the patient will be aware that they are seeing a GP and may trust the initial assessment process (M), therefore finding being streamed to a GP acceptable (O). | • Patients are more concerned with timeliness rather than who they see. • Communication is a key mechanism here. Important factors: speedy, appropriate, knowledgeable. • Might depend on patient’s condition and why they have gone to ED. • Depends on how ill the patient feels or how worried they are. |
Clinician-derived | Patients who are assessed in an ED primary care service model and streamed or redirected to a booked appointment with their community primary care service or hospital-based OOH GP service (C) will not have to wait in the ED to be seen and can be seen locally that day, or go home and return for an appointment at the OOH primary care service later (M), so may find being steamed to other primary care services acceptable (O). | • Might be time consuming, some patients may not find being sent away acceptable • Safety concerns if patients do not attend the community primary care service. • Depends on how unwell they feel. • What is the wait to get an appointment? Still faster than a GP appointment? • Depends on whether they wanted/expected to see a GP. • How far away they live, availability of parking. • Has a good explanation been given? |
Clinician-derived | When patients with a non-urgent care problem which could be dealt with in primary care present to an outside-onsite service model (C) which redirects them to their community GP service, leading to them waiting and being seen twice before being sent away (M), they may find the streaming and redirection process not acceptable (O). | • ‘Unacceptable’ depends on severity of symptoms. • Patients may be left feeling they should not have gone to ED. • How they are treated is important, patients need reassurance that it is okay to go home. • Quality of communication is important; an outcome that has an appointment is okay. 2 stops is not good, 1 stop is ideal – patient might feel ‘fobbed off’. |